Mielopatia associada ao vírus linfotrópico humanode células T do tipo 1 (HTLV-1)

Abstract

HTLV-1-associated myelopathy (HAM), also known as tropical spastic paraparesis (TSP), is a chronic progressive demyelinating disease that affects the spinal cord and white matter of the central nervous system. The lifetime incidence of HAM in HTLV-1 carriers is estimated to be less than 5%. Typical time of onset is in the fourth decade of life, with a female-to-male rate of 2:1. Gait disturbance and weakness and stiffness of the lower limbs are common presenting signs and symptoms of HAM. Lower extremities are affected to a much greater degree than upper extremities. Spasticity may be moderate to severe, and lower back pain is common. As the disease progresses, bladder and bowel dysfunction can occur. Sensory involvement is generally mild and can result in a variable degree of sensory loss and dysesthesia. Results of magnetic resonance imaging may be normal, or the scans show atrophy of the spinal cord and nonspecific lesions in the brain. Immunologic evidence suggests that an immune mechanism may play a role in the development of HAM. There is no effective treatment for the myelopathy. Corticosteroids, and INF-gamma may produce transient responses. Danazol, an anabolic steroid, does not improve gait and bladder function. The value of zidovudine (anti-retroviral agent) in the treatment has not been defined yet.

Postural Profile of Patients With Ham/Tsp: Computerized and Baropodometric Assessment

“…In the pathology in question, all the muscle groups can be affected especially the flexor and adductor muscles of the lower limbs. (7,18) In this study, the proportion that becomes more severe the effect of HAM/TSP in terms of postural misalignment, the greater the weight load in a particular area of the foot.…”

“…(6) The HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is characterized as a demyelinating, slow and progressive chronic inflammatory disease of the central nervous system. (7) The first manifestations of disease occur in the fourth decade of life, with a ratio of 2:1 female to male. (6) The virus affects the spinal cord determining the appearance of severe clinical syndrome due to motor disabilities affecting the lower limbs and lumbar spine, together with the associated autonomic dysfunction.…”

“…In the predominant clinical condition of HAM/TSP, biomechanical, sensory and functional alterations are observed, characterized by the reduction in muscle strength of the pelvic girdle and lower limbs, low lumbar pain, gait disturbances, spastic hypertonia, muscle shortening and joint hypomobility, which predispose individuals to abnormal posture. (7,8,9) In view of this context and due to the lack of studies with an objective postural assessment of individuals with HAM/TSP, it is necessary to describe and correlate postural deviations and the type of predominant weight load.…”

Human T-cell lymphotropic virus types I and II infections in a cohort of patients with neurological disorders in Belém, Pará, Brazil

“…The fact that almost 90% of our patients reacted seronegative underscores the need for a routine differential diagnosis of HTLV-I/IIrelated neurological disorders with a variety of other clinical conditions which might be gathered in the context of either acute or chronic myelopathies 30 . In tropical regions like ours, parasitic diseases including toxoplasmosis, schistosomiasis and cysticercosis, for example, cannot be ruled out when seeking for the etiology of neurological disorders that might resemble some of those of HAM/TSP.…”

Aplicabilidade, validação e reprodutibilidade do <i>Spinal Cord Independence Measure</i> <i>version III</i> (SCIM III) nos pacientes com paraparesia espástica

“…Na marcha em tesoura, os passos tornam-se arrastados e lentos, há alteração do equilíbrio, comprometendo as fases da marcha. Os movimentos perdem sua seletividade, provocando uma deficiência no sinergismo funcional entre as cinturas escapular e pélvica, com acentuada hipomobilidade da articulação sacro-ilíaca e aumento do gasto energético (RIBAS; MELO, 2002;LANNES et al, 2006), o que levará a restrição na deambulação comunitária e o paciente necessitará de suporte …”